1548496417 NPI number — MS. KATHLEEN SACHIKO VANCE LCSW, CSAC

Table of content: MS. KATHLEEN SACHIKO VANCE LCSW, CSAC (NPI 1548496417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548496417 NPI number — MS. KATHLEEN SACHIKO VANCE LCSW, CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANCE
Provider First Name:
KATHLEEN
Provider Middle Name:
SACHIKO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CSAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANCE
Provider Other First Name:
KATHY
Provider Other Middle Name:
SACHIKO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, CSAC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548496417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
442 KANANI PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-224-8551
Provider Business Mailing Address Fax Number:
808-595-6451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JARRETT WHITE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRIPLER ARMY MEDICAL CENTER
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-7699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1150-02 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 3289 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)